BACKGROUND: Hepatitis E virus (HEV) is endemic in EU/EEA countries, but the understanding of the burden of the infection in humans is inconsistent as the disease is not under EU surveillance but subject to national policies. STUDY: Countries were asked to nominate experts and to complete a standardised questionnaire about the epidemiological situation and surveillance of HEV in their respective EU/EEA country. This study reviewed surveillance systems for human cases of HEV in EU/EEA countries and nominated experts assessed the epidemiology in particular examining the recent increase in the number of autochthonous cases. RESULTS: Surveillance systems and case definitions across EU/EEA countries were shown to be highly variable and testing algorithms were unreliable. Large increases of autochthonous cases were reported from Western EU/EEA countries with lower case numbers seen in Northern and Southern European countries. Lack of clinical awareness and variability in testing strategies might account for the observed differences in hepatitis E incidence across EU/EEA countries. Infections were predominantly caused by HEV genotype 3, the most prevalent virus type in the animal reservoirs. CONCLUSION: Discussions from the expert group supported joint working across countries to better monitor the epidemiology and possible changes in risk of virus acquisition at a European level. There was agreement to share surveillance strategies and algorithms but also importantly the collation of HEV data from human and animal populations. These data collected at a European level would serve the 'One Health' approach to better informing on human exposure to HEV.

European Centre for Disease Prevention and Control Stockholm Sweden

European Centre for Environment and Human Health University of Exeter United Kingdom

European Food Safety Authority Parma Italy

Greek Center for Disease Prevention and Control Athens Greece

Health Board Tallinn Estonia

Health Service Executive Health Protection Surveillance Centre Dublin Ireland

Institut de veille sanitaire Saint Maurice France

National Center for Epidemiology Budapest Hungary

National Health Services Health Scotland Glasgow United Kingdom

National Infection Service Public Health England London United Kingdom

National Institute for Health and Welfare Finland

National Institute for Public Health and the Environment Bilthoven Netherlands

National Institute of Health Dr Ricardo Jorge Lisboa Portugal

National Institute of Health Rome Italy

National Institute of Public Health Prague Czech Republic

Norwegian Institute of Public Health Oslo Norway

Paul Ehrlich Institut Langen Germany

Public Health Agency of Sweden Stockholm Sweden

Robert Koch Institute Berlin Germany

Spanish National Centre of Microbiology Carlos 3 Institute of Health Madrid Spain

Statens Serum Institut Copenhagen Denmark

World Health Organization Regional Office for Europe Copenhagen Denmark

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